Where HEXP is the logarithm of per capita health care spending, GDP is the
logarithm of per capita gross domestic product, and the numbers in parenthesis
are t values. The U.S. figure falls near the upper bound of a 95 percent
confidence interval. Figures for the higher-income countries, such as Denmark,
Luxembourg and Norway fall closer to the lower bound, possibly because of
underreporting of certain types of expenditures, such as nursing home care. See
Bengt Jonsson, "What Can Americans Learn from Europeans?", p. 83.

The
analysis that follows is based on Neuschler, Canadian Health Care, pp. 37-53.
For a critique of this approach see Morris L. Barer, W. Pete Welch and Laurie
Antioch, "Canadian/U.S. Health Care: Reflections on the H IAA's Analysis,"
Health Affairs, Fall 1991, pp. 229-236.

Leroy L. Schwartz, "The Medical Cost of America's Social Ills," Wall Street
Journal, June 24,1991. See also Spencer Rich, "Tracing Medical Costs to
Social Problems," Washington Post, August 28,1991.

See
the discussion in Neuschler, Canadian Health Care, p. 50.

This
section is based on Dale A. Rublee and Markus Schneider, "International Health
Spending: Comparisons With the OECD," Health Affairs, Fall 1991, pp.
187-198. See, however, a critique of this approach in George J. Schieber and
Jean-Pierre Poullier, "Advancing the Debate on International Spending
Comparisons," Health Affairs, Fall 1991, pp. 199-201.

The treatment for patients with chronic renal failure and
the use of CAT scanners continued its rise in virtually every country throughout
the 1980s – an acknowledgment of the medical value of these innovations. Some
have argued that the U.S. went too far in its use of pacemaker implants,
however.

See
John C. Goodman, National Health Care in Great Britain (Dallas: Fisher
Institute, 1980), pp. 96-104.

Day
and Klein, "Britain's Health Care Experiment," p. 43. For discussion of British
hospital rationing, see Goodman, National Health Care in Great Britain,
ch. 6. Enoch Powell, former Minister of Health, has argued that waiting lines
are inevitable under the NHS, regardless of the resources devoted to health
care. See Enoch Powell, Medicine and Politics, 1975 and After (New York:
Pitman, 1976).

For
an analysis of the waiting list in New Zealand, see Choices for Health Care:
Report of the Health Benefits Review (Wellington: Health Benefits Review
Committee, 1986), pp. 78-79.

Estimate of the Fraser Institute (Vancouver) based on sampling in five Canadian
Provinces.

Hospital admissions as a percent of the total population average 16.1 percent
for all OECD countries. The figures are 15.9 percent for the United Kingdom, 13
percent for New Zealand and 14.5 percent for Canada. See Schieber et al.,
"Health Systems in Twenty-four Countries," Exhibit 4, p.27.

Health insurance industry officials in the United States report that about 4
percent of the population consumes about 50 percent of health care costs. See
Blue Cross/Blue Shield, Reforming the Small Group Health Insurance Market
(Chicago: BC/BS, 1991), p. 6.

For
example, in Ontario in 1989 the number of people waiting for open-heart surgery
equaled more than 25 percent of the total surgeries performed. Because of
special efforts to reduce the waiting lists, Ontario achieved a rate of one
person waiting for every seven surgeries by January 1991. See C. David Naylor,
"A Different View of Queues in Ontario," Health Affairs, Fall 1991, pp.
115­116.

General Accounting Office, Canadian Health Insurance: Lessons for the United
States, June 1991, Table 4. 1, p. 55.

See,
for example, Joan Breckenridge, "Grief, Frustration Left in Wake Of Man Who Died
on Waiting List," Globe and Mail (Ontario), January 25, 1989.

For
Britain, see the discussion in Enthoven, "Internal Market Reform of the British
Health Service." A Canadian observer reports that "Ontario hospitals lag at
least a decade behind their U. S. counterparts in expenditure tracking and
management information systems. "See Naylor, "A Different View of Queues in
Ontario, "p.112.

For
New Zealand, estimate of the New Zealand Department of Health. OECD Statistics
show an occupancy rate of 74.8 percent for New Zealand in 1983 and 83.3 percent
for Canada. See Organization for Economic Cooperation and Development,
Financing and Delivering Health Care (Paris: OECD, 1987), Table 29, p. 67.
The most recent OECD statistics are expected to show an occupancy rate of 80.3
percent for acute care hospitals and 82.7 percent for all hospitals in Canada
for 1987. See George J. Schieber et al.. "Health Care Systems in Twenty-four
Countries," Exhibits 4 and 5, pp. 27.29.

For
an analysis of international length of stay statistics, see Rita
Ricardo-Campbell, The Economics and Politics of Health (Chapel Hill, NC:
University of North Carolina Press, 1982), Table 3, p.85: and Cotton M. Lindsay
et al., National Health Issues: The British Experience (Nutley, NJ:
Hoffmann-LaRoche, Inc., 1980), pp. 74-78.

Quoted in Economic Models, Ltd., The British Health Care System (Chicago:
American Medical Association, 1976),p.33.

Quoted in Harry Swartz, "The Infirmity of British Medicine," in Emmett Tyrrell,
Jr., ed., The Future That Doesn't Work: Social Democracy's Failures in
Britain (New York: Doubleday, 1977), p. 24.

British Medical Journal,
December 12,1942, p. 700.

Aneurin Bevan, In Place of Fear (London: Heinemann, 1952), p.76.

Inequalities in Health
(Black report), (London: Department of Health and Social Security, 1980).

See
Julian LeFrand, "The Distribution of Public Expenditure: The Case of Health
Care," Economica, Vol. 45, No. 178, 1978: Anthony J. Culyer, Need and the
National Health Service (Totowa, NJ: Rowman and Lettlefield, 1976); Michael
H. Cooper, Rationing Health Care (New York: Halstead Press, 1975);
Michael H. Cooper and Anthony J. Culyer, "Equality in the N.H.S.: Intentions,
Performance and Problems in Evaluation," in M. M. Houser, ed., The Economics
of Medical Care (London: Allen and Unwin, 1972); J. Noyce, A. A. Snaith and
A. J. Trickey, "Regional Variations in the Allocation of Financial Resources to
the Community Health Services," The Lancet, March 30,1974; and Goodman,
National Health Care in Great Britain, ch. 9. For a recent update on
government failures to make any progress in achieving equality of access to
health care, see "Dying of Inequality," The Economist, April 4,1987, p.
52.

Noyce, Snaith and Trickey, "Regional Variations in the Allocation of Financial
Resources to the Community Health Service," Table III, p. 556.

Julian LeGrand, "The Distribution of Public Expenditure: The Case of Health
Care," Economica, Vol. 45, No. 178, May 1978.

See
Ingemar Stahl, "Can Equity and Efficiency Be Combined: The Experience of the
Planned Swedish Health Care System," in Mancur Olson, ed., A New Approach to
the Economics of Health Care (Washington, DC: American Enterprise Institute,
1981), pp. 187-190.

Cotton M. Lindsay, Canadian National Health Insurance: Lessons for the United
States (Nutley, NJ: Hoffmann-LaRoche, 1979).

Choices for Health Care,
pp. 19-22.

General Office of Accounting, Canadian Health Insurance, pp. 53 ff.

Areview of the
hospital records of open-heart surgery patients in Toronto found that while
physicians generally assign sensible priorities, there were "many instances of
relatively short waits for elective cases while more urgent cases waited
inappropriately long periods of time." See Naylor, "A Different View of Queues
in Ontario," p.121.

For
example, one study claimed that administrative costs in the United States were
between 19.3 percent and 24.1 percent of total health care spending and
accounted for more than half the difference in cost between the U. S. and
Canadian systems. See Steffie Woolhandler and David Himmelstein, "The
Deteriorating Administrative Efficiency of the U. S. Health Care System,"
New England Journal of Medicine, Vol. 324, No. 18, May 2,1991, pp. 1253-1258. See also a critique of the study's methodology by the Health Insurance
Association of America in Medical Benefits, Vol. 8, No. 10, May 30, 1991, p. 5. In another
study, a national health insurance advocacy group, Citizen Fund. claimed that
33.5 cents of every dollar spent by private health insurance was for overhead
expenses. See Richard Koenig. "Insurers' Overhead Dwarfs Medicare's," Wall
Street Journal, November
15, 1990. The results of other studies are reviewed below.

For
critiques of these estimates, see 'GAO Report on Canadian Health Care Tainted by
Charges of Partisanship," Health Benefits Letter,
Vol. 1, No. 16, September 18, 1991; and the letters to the editor in the New
England Journal of Medicine. Vol. 325. No. 18. pp. 1316-1319.

See
G. M. Anderson, J. P. Newhouse and L. L. Roos, "Hospital Care for Elderly
Patients with Diseases of the Circulatory System: A Comparison of Hospital
Use in the United States and Canada," New England Journal of Medicine,
Vol. 321, 1989, pp. 1443-1448: and the discussion in Naylor, "A Different View of Queues
in Ontario," pp. 117-118.

Phillip J. Held, Ph.D. et al., "Access to Kidney Transplantation: Has the United
States Eliminated Income and Racial Differences?", Archives of Internal
Medicine, Vol. 148, December 1988, pp. 2594-2600. A possible reason for the
discrepancy is Medicare reimbursement policies, which place greater burdens on
lower-income patients. Prior to 1987 (the period covered by the study), Medicare
did not pay for outpatient drugs such as cyclosporine – which can cost
transplant patients up to $5,000 per year. It would be irrational to spend
$50,000 on a transplant and have it rejected because the patient could not
afford $5,000 in medication. Currently, Medicare pays for 80 percent of
immunosuppressive drugs for one year.

Ibid., p. 884. See also Elena
Mezentseva and Natalia Rimachevskaya, "The Soviet Country Profile: Health of the
U.S.S.R. Population
in the 70s and 80s: An Approach to a
Comprehensive Analysis," Social Science and
Medicine, Vol.
31, No. 8, pp. 867­877.

Aldona Robbins and Gary Robbins, "What a Canadian-style Health Care System Would
Cost U.S. Employers and Employees." National Center for Policy Analysis, NCPA
Policy Report No.
145, February 1990.

Ibid.

Ibid.

See
Robbins and Robbins, "What a Canadian-style Health Care System Would Cost U.S.
Employers and Employees", pp. 20­22.

These and other statistics in this section are taken from Department of Health
an Social Security, Health and Personal Social Services for England,
1985 and 1991 editions (London: Her
Majesty's Stationery Office, 1985 and 1991).

New
charges for these services were introduced in the spring of 1989, however.

See
John C. Goodman, "The Envy of the World?", in Arthur Seldon, ed., The Litmus papers: A
National Health Disservice(London: Centre
for Policy Studies, 1980), pp. 125-132; and Goodman, National Health Care in
Great Britain,
pp. 192-196.